Identifying Primary Care Pathways Fromquality Of Care To Outcomes And Satisfaction Using Structural Equation Modeling

ObjectiveTo study the relationships between the different domains of quality of primary health care for the evaluation of health system performance and for informing policy decision making.Data SourcesA total of 137 quality indicators collected from 7,607 English practices between 2011 and 2012.Study DesignCross-sectional study at the practice level. Indicators were allocated to subdomains of processes of care (quality assurance, education and training, medicine management, access, clinical management, and patient-centered care), health outcomes (intermediate outcomes and patient-reported health status), and patient satisfaction. The relationships between the subdomains were hypothesized in a conceptual model and subsequently tested using structural equationmodeling.Principal FindingsThe model supported two independent paths. In the first path, access was associated with patient-centered care (=0.63), which in turn was strongly associated with patient satisfaction (=0.88). In the second path, education and training was associated with clinical management (=0.32), which in turn was associated with intermediate outcomes (=0.69). Patient-reported health status was weakly associated with patient-centered care (=-0.05) and patient satisfaction (=0.09), and not associated with clinical management or intermediate outcomes.ConclusionsThis is the first empirical model to simultaneously provide evidence on the independence of intermediate health care outcomes, patient satisfaction, and health status. The explanatory paths via technical quality clinical management and patient centeredness offer specific opportunities for the development of quality improvement initiatives.