The quality of ambulatory-based primary care: a framework and recommendations

GOAL OF THE FRAMEWORK: The goal of the framework described in this review article is to provide a comprehensive model for the development of quality improvement programs in ambulatory-based primary care currently being tested at the University of Missouri-Columbia. This review article assesses the past and present, and speculates on the future, of quality improvement in primary care through a comprehensive review of 30 years of literature.

(1) Although much of the past literature in the quality area has been concentrated in hospital care, there is a strong tradition in ambulatory-based primary care. (2) Past incentives promoted to a large extent hospital-based quality assurance, prospects for health reform and the result of recent quality initiatives will in the future promote improved methods for ambulatory-based quality. (3) There are unique dimensions of primary care that must be taken into account to accurately, appropriately, and comprehensively measure its quality. (4) A systematic process for the development of quality improvement that takes the perspective of those closest to the care being assessed, in this case the primary care provider, is necessary to develop a meaningful system. (5) Recommendations for further work in this arena are offered as they relate to both the health care system and providers.