The Primary Care Assessment Survey: Tests of Data Quality and Measurement Performance

• Published in: Medical care Vol. 36; no. 5; pp. 728 - 739
• Main Authors: Safran, Dana Gelb, Kosinski, Mark, Tarlov, Alvin R., Rogers, William H., Taira, Deborah A., Lieberman, Naomi, Ware, John E.
• Format: Journal Article
• Language: English
• Published: United States J. B. Lippincott-Raven Publishers 01-05-1998; Lippincott-Raven Publishers
• Subjects: Adult; Brief Reports; Health care delivery; Health Care Surveys - standards; Health Care Surveys - statistics & numerical data; Health Knowledge, Attitudes, Practice; Humans; Interpersonal communication; Massachusetts; Organizational communication; Outcome Assessment (Health Care) - standards; Outcome Assessment (Health Care) - statistics & numerical data; Patient care; Patient controlled analgesia; Physical examinations; Physicians; Population Surveillance; Primary health care; Primary Health Care - standards; Primary Health Care - statistics & numerical data; Principal components analysis; Psychometrics; Reproducibility of Results; Research Design; Surveys and Questionnaires; Massachusetts
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/00005650-199805000-00012

Objectives. The authors examine the data quality and measurement performance of the Primary Care Assessment Survey (PCAS), a patient-completed questionnaire that operationalizes formal definitions of primary care, including the definition recently proposed by the Institute of Medicine Committee on the Future of Primary Care. Methods. The PCAS measures seven domains of care through 11 summary scales: accessibility (organizational, financial), continuity (longitudinal, visit-based), comprehensiveness (contextual knowledge of patient, preventive counseling), integration, clinical interaction (clinician-patient communication, thoroughness of physical examinations), interpersonal treatment, and trust. Data from a study of Massachusetts state employees (n = 6094) were used to evaluate key measurement properties of the 11 PCAS scales. Analyses were performed on the combined population and for each of the 16 subgroups defined according to sociode-mographic and health characteristics. Results. The 11 PCAS scales demonstrated consistently strong measurement characteristics across all subgroups of this adult population. Tests of scaling assumptions for summated rating scales were well satisfied by all Likert-scaled measures. Assessment of data completeness, scale score dispersion characteristics, and inter-scale correlations provide strong evidence for the soundness of all scales, and for the value of separately measuring and interpreting these concepts. Conclusions. With public and private sector policies increasingly emphasizing the importance of primary care, the need for tools to evaluate and improve primary care performance is clear. The PCAS has excellent measurement properties, and performs consistently well across varied segments of the adult population. Widespread application of an assessment methodology, such as the PCAS, will afford an empiric basis through which to measusre, monitor, and continuously improve primary care.