Methods for measuring comprehensiveness in primary care: a narrative review
Derek Baughman
1 , Rafay Nasir 2 * , Andrew Bazemore 1
1
2
Abstract
Comprehensiveness in primary care is defined as managing most medical needs in a population while integrating the context of patient’s values, preferences, and beliefs. This study aims to synthesise validated measures for measuring comprehensiveness in primary care to facilitate its practical application.
The objective of this study was to synthesise validated measures for measuring comprehensiveness in primary care, facilitating its practical application.
A narrative-style literature review was employed to conduct a hierarchical review of relevant literature. The process involved several stages: initial term filtering, separation of primary care from specialist care using medical subject heading (MeSH) terms, incorporation of non-MeSH terminology, and a manual review of titles, abstracts, and full articles. Articles were included if they discussed the measurement, assessment, or application of comprehensiveness in primary care and were relevant to primary care and methodologically sound. A multistage PubMed search of ‘comprehensiveness’ (MeSH) with hierarchical sub-term filtering and snowball method gleaning of additional articles from literature-described terminology was conducted.
Thirteen studies met the inclusion criteria. Methodological strategies varied from claims-based approaches for cost and utilisation to surveys assessing the scope of clinical services and patient experience.
Thoroughly measuring comprehensiveness in primary care integrates methods that evaluate the effect of physician ranges of clinical services on the cost and utilisation of health care, and the impact on patient outcomes within the context of the patient experience. Implementing these methods pragmatically can assist communities and health systems in implementing, measuring, and capturing comprehensiveness in primary care.
Keywords: comprehensiveness, family medicine, health services research, health systems, holistic care, integrated care, population health, primary care, range of services, scope of care, value based care, whole person care.
References
1 Millis JS. The Millis Commission report. GP 1966; 34(6): 173-188 contd.
| Google Scholar | PubMed |
4 Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005; 83(3): 457-502.
| Crossref | Google Scholar | PubMed |
5 Baughman D, Nasir R, Ngo L, et al. Defining comprehensiveness in primary care: a scoping review. J Prim Health Care 2023; 15(3): 253-261.
| Crossref | Google Scholar | PubMed |
6 Ferrari R. Writing narrative style literature reviews. Med Writ 2015; 24: 230-235.
| Crossref | Google Scholar |
7 Lindner S, Kaufman MR, Marino M, et al. A Medicaid Alternative Payment Model Program in Oregon led to reduced volume of imaging services. Health Aff 2020; 39(7): 1194-1201.
| Crossref | Google Scholar | PubMed |
8 Bazemore A, Petterson S, Peterson LE, et al. More comprehensive care among family physicians is associated with lower costs and fewer hospitalizations. Ann Fam Med 2015; 13(3): 206-213.
| Crossref | Google Scholar | PubMed |
9 Petterson S, Bazemore AW, Phillips RL, et al. Rewarding family medicine while penalizing comprehensiveness? Primary care payment incentives and health reform: the Patient Protection and Affordable Care Act (PPACA). J Am Board Fam Med 2011; 24(6): 637-638.
| Crossref | Google Scholar | PubMed |
10 Schultz SE, Glazier RH. Identification of physicians providing comprehensive primary care in Ontario: a retrospective analysis using linked administrative data. CMAJ Open 2017; 5(4): E856-E863.
| Crossref | Google Scholar | PubMed |
11 Rosenblatt RA, Hart LG, Gamliel S, et al. Identifying primary care disciplines by analyzing the diagnostic content of ambulatory care. J Am Board Fam Pract 1995; 8(1): 34-45.
| Google Scholar | PubMed |
12 Weiner JP, Starfield BH. Measurement of the primary care roles of office-based physicians. Am J Public Health 1983; 73(6): 666-671.
| Crossref | Google Scholar |
13 Henry TL, Petterson S, Phillips RS, et al. Comparing comprehensiveness in primary care specialties and their effects on healthcare costs and hospitalizations in Medicare beneficiaries. J Gen Intern Med 2019; 34(12): 2708-2710.
| Crossref | Google Scholar | PubMed |
14 O’Malley AS, Rich EC, Shang L, et al. New approaches to measuring the comprehensiveness of primary care physicians. Health Serv Res 2019; 54(2): 356-366.
| Crossref | Google Scholar | PubMed |
15 O’Malley AS, Rich EC, Shang L, et al. Practice-site-level measures of primary care comprehensiveness and their associations with patient outcomes. Health Serv Res 2021; 56(3): 371-377.
| Crossref | Google Scholar | PubMed |
16 Rich EC, O'Malley AS, Burkhart C, et al. Primary care practices providing a broader range of services have lower Medicare expenditures and emergency department utilization. J Gen Intern Med 2021; 36(9): 2796-2802.
| Crossref | Google Scholar |
17 Shi L, Starfield B, Xu J. Validating the adult primary care assessment tool. J Fam Pract 2001; 50(2): 15.
| Google Scholar |
18 O’Malley AS, Rich EC. Measuring comprehensiveness of Primary Care: challenges and opportunities. J Gen Intern Med 2015; 30(Suppl 3): 568-575.
| Crossref | Google Scholar | PubMed |
19 Etz RS, Zyzanski SJ, Gonzalez MM, et al. A new comprehensive measure of high-value aspects of primary care. Ann Fam Med 2019; 17(3): 221-230.
| Crossref | Google Scholar | PubMed |
20 Centers for Medicare & Medicaid Services. Restructured BETOS Classification System. Available at https://data.cms.gov/provider-summary-by-type-of-service/provider-service-classifications/restructured-betos-classification-system [accessed 28 November 2022].
21 Schneeweiss R, Rosenblatt RA, Cherkin DC, et al. Diagnosis clusters: a new tool for analyzing the content of ambulatory medical care. Med Care 1983; 21(1): 105-122.
| Crossref | Google Scholar | PubMed |
22 Zyzanski SJ, Gonzalez MM, O’Neal JP, et al. Measuring primary care across 35 OECD countries. Ann Fam Med 2021; 19(6): 547-552.
| Crossref | Google Scholar | PubMed |
23 Tse ETY, Lam CLK, Wong CKH, et al. Exploration of the psychometric properties of the Person-Centred Primary Care Measure (PCPCM) in a Chinese primary care population in Hong Kong: a cross-sectional validation study. BMJ Open 2021; 11(9): e052655.
| Crossref | Google Scholar | PubMed |
24 Agency for Healthcare Research and Quality. What Are CAHPS Surveys? CAHPS Patient Experience Surveys and Guidance. Available at https://www.ahrq.gov/cahps/surveys-guidance/index.html [accessed 26 March 2023].
25 NHS England. GP Patient Survey. Statistical work areas. Available at https://www.england.nhs.uk/statistics/statistical-work-areas/gp-patient-survey/ [accessed 26 March 2023].
