Core Principles to Improve Primary Care Quality Management

J Am Board Fam Med. Nov-Dec 2018;31(6):931-940. doi: 10.3122/jabfm.2018.06.170172.


Quality management in American health care is in crisis. Performance measurement in its current form is costly, redundant, and labyrinthine. Increasingly, its contribution to achieving the Quadruple Aim is under close examination, especially in the domain of primary care services, where the burden of measurement is heaviest. This article assesses the state of quality management in primary care in the United States, particularly the 2015 Medicare Access and Children's Health Insurance Program Reauthorization Act, in comparative perspective, drawing lessons from the Quality and Outcomes Framework in the United Kingdom. The health care delivery function specific to primary care is pivotal to crossing the quality chasm, yet prior efforts to improve the quality of this function have failed more often than succeeded. These failures are the result of quality programs unguided by core principles of primary care. Quality management in primary care requires a more disciplined approach, adherent to 4 foundational principles: optimizing holistic patient and population health; harnessing the Quadruple Aim as a dynamic whole; applying measurements as tools for quality, not outcomes of quality; and prioritizing therapeutic relationships. These principles serve as the foundation for a bridge to high-functioning primary care that will lead American health care closer to the Quadruple Aim.

Keywords: Children's Health Insurance Program; Medicare; Population Health; Primary Health Care; Quality of Health Care.

MeSH terms

  • Cross-Cultural Comparison*
  • Medicare Access and CHIP Reauthorization Act of 2015*
  • Practice Guidelines as Topic
  • Primary Health Care / organization & administration*
  • Primary Health Care / standards
  • Quality Improvement / organization & administration*
  • Quality Improvement / standards
  • United Kingdom
  • United States