Less AND More Are Needed to Assess Primary Care

Rebecca S. Etz; Martha M. Gonzalez; E. Marshall Brooks; Kurt C. Stange

doi:10.3122/jabfm.2017.01.160209

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Table 1.

Clinician Responses (n = 3,524) Coded Using a Combination of 1) Measures-based Coding and 2) Emergent Coding

Measure-based codes used (n = 27) informed by measures used and located with the following entities: National Committee for Quality Assurance, Healthcare Effectiveness Data and Information Set, National Quality Forum, and the Agency for Healthcare Research and Quality
Code Group	Codes in code group	Percent responses to which group code applied^*
Measure-based	Chronic disease; control of disease; counseling; evidence-based medicine, guidelines, benchmarks; prevention, immunization, vaccination; risk stratification; access; continuity; documentation or recording; follow up; medication management; patient received something; patient satisfaction; patient understands doctor; productivity; referrals, tracking systems; cost and utilization; written care plan; compliance or adherence; specific targets; quality of life; functional status; rates or percentages of population	57.7%

Emergent codes used (n = 65) based on concepts identified through the patterned appearance of key words, phrases, or ideas as determined through iterative data reading and discussion by three co-authors (RSE, MMG, EMB)
Patient-focused	Ask the patient; family; patient real understanding; patient as partner or team member; patient experience and perspective; patient feels known; patient goals or values; patient involved in decisions of care; patient needs are met; patient outreach; personalized or tailored care	7.5%
Patient-centered	Engagement; patient centered; patient education; patient grade of practice; patient responsibility	18.8%
Tenets of primary care	Comprehensiveness; coordination, including transitions; equity and social justice; longitudinal; problem recognition; relationship or trust; wholism or whole person	12.5%
Employee focus	Collaborative; employee satisfaction, joy, retention, turnover; interprofessional or multidisciplinary; staff; team talk; top of license/skill set; training, continuing education	12.0%
Work processes	Efficiency; electronic medical record; information management; learning organization; self assess, adapts, changes; quality improvement; timeliness	13.6%
Practice qualities	Communication; integration; promotion of health or wellness; qualities a practice should have; health information technology; transparency	10.8%
Outside clinic walls	Community connections, practice networks; more, less, limit, too much, too little of something; payment; social determinants of health	4.5%
Clinicians	Advocates for patients and communities; understands the patient; competent and up to date; empathy, caring, compassion, respect; complexity and ambiguity, listens to or talks to patient; qualities a clinician should have; setting priorities	13.5%
Care focus	Appropriate; behavioral health, substance use; care agnostic to constraints; right care, right time, right place; targeted condition or type of care; weight, food, nutrition, physical activity	11.2%
Patient talk	Care management; litmus test; missing measures; social history and habits (not smoking); symptom reduction; weighing of risks and benefits	2.6%