Does patient assessment of the quality of the primary care they receive predict subsequent outcomes? An Oklahoma Physicians Resource/Research Network (OKPRN) study

Abstract

Introduction: We analyzed data from a cohort of 782 older patients assembled in 1999 to 2000 to determine whether baseline patient assessments of the quality of the primary care services they had received, measured using the Components of Primary Care Index (CPCI), were associated with subsequent changes in health-related quality of life (HRQoL) and/or survival.

Methods: Longitudinal growth curve models were used to analyze changes in Quality of Well-Being (QWB-SA) scores over an average (S.D.) of 2.07 (1.07) years. Cox proportional hazards models were used to identify variables associated with mortality over an average of 8.26 years (6460 person-years). To reduce confounding by severity of illness, subjects were stratified into disabled, nondisabled high utilizers of primary care, and nondisabled low utilizers. Within subgroups, we controlled for number of chronic illnesses and scores on the General Health subscale of the Medical Outcomes Study Short Form-36 (SF-36). We also controlled for baseline age, sex, marital status, income, body mass index, educational attainment, duration of the relationship with current primary care physician (PCP), and number of visits to the PCP in the year before enrollment. Analyses took into account clustering of patients within PCP.

Results: Neither total CPCI nor any CPCI subscale score was associated with QWB-SA change over time. Higher ratings of Coordination of Care were associated with reduced survival in the disabled and nondisabled high utilizer subgroups (P = .007).

Conclusions: Assuming that effective primary care results in better HRQoL and longer survival and that the CPCI captures important primary care attributes, older patients' level of satisfaction with the quality of their primary care may not be a good surrogate measure of effectiveness.