Identifying Primary Care Pathways from Quality of Care to Outcomes and Satisfaction Using Structural Equation Modeling

Abstract

Objective. To 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 Sources. A total of 137 quality indicators collected from 7,607 English practices between 2011 and 2012. Study Design. Cross-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 equation modeling. Principal Findings. The model supported two independent paths. In the first path, "access" was associated with "patient-centered care" (b = 0.63), which in turn was strongly associated with "patient satisfaction" (b = 0.88). In the second path, "education and training" was associated with "clinical management" (b = 0.32), which in turn was associated with "intermediate outcomes" (b = 0.69). "Patient-reported health status" was weakly associated with "patient-centered care" (b = À0.05) and "patient satisfaction" (b = 0.09), and not associated with "clinical management" or "intermediate outcomes." Conclusions. This 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.

Patient Satisfaction in the Spanish National Health Service: Partial Least Squares Structural Equation Modeling

“…Previous studies [61][62][63] showed how structural equation modeling (SEM) could become an indispensable tool for managers, policymakers, and regulators in the healthcare sector. Our data came from indexes, as mentioned above, and were contained in a database; therefore, they were secondary data.…”

Health Investment Management and Healthcare Quality in the Public System: A Gender Perspective

“…The latter could be due to patients’ necessary dependence on the health system [ 60 ]. Other research found a weak relationship between health condition and satisfaction [ 48 , 61 ]. However, in general, studies have found a negative relationship between mortality and patient satisfaction [ 62 , 63 , 64 ].…”

“…The importance of patient satisfaction research is that high satisfaction is associated with better clinical outcomes [ 47 ] and thus system quality. Some authors state that it may be a “cause–effect” relationship because satisfied patients may be more adherent to treatment and thus achieve better clinical outcomes [ 48 ]. For example, Chia confirmed that patient participation in the process of diagnosis and the degree of patient involvement in healthcare decision-making are associated with patient satisfaction [ 49 ].…”

A Standard Set of Value-Based Patient-Centered Outcomes and Measures of Overall Health in Adults

“…Furthermore, it leaves out aspects of overall health that are not specific of a particular condition-specific set, such as those relevant to people with multimorbidity and polypharmacy [ 12 ]. These limitations undermine the appraisal of the value of services oriented towards health promotion and prevention, such as public health and primary care services [ 13 ]. Moreover, it is at odds with the renewed recognition of the essential role that these services play within health care systems and the support for primary care and public health functions as the core of integrated health services and one of the three pillars of the WHO’s primary health care approach [ 14 ].…”