A key informant "tree" as a tool for community oriented primary care. The Cleveland COPC Group

Although community oriented primary care (COPC) is conceptually appealing, lack of practical methodology has limited its application. To implement the initial portions of COPC, most practitioners need to have available inexpensive, quick methods of doing community assessment. Use of community members identified as key informants is one method for conducting the qualitative portion of a community assessment. A key informant "tree" was developed at an inner city health center to analyze its costs, benefits, and limitations as a tool for COPC.

Using a semi-structured format, 14 of 24 key informants were interviewed using open-ended, closed-ended, and rating questions. An analysis was conducted of the costs of this approach and of the responses received.

Planning and implementation of the tree took 6 hours of physician time and 8 hours of nonphysician time. Useful data was obtained from each of the different types of questions, although it appeared best suited to open-ended questions. Response bias was an important problem. The key informant approach appeared most useful with informal community leaders.

With appropriate recognition of the potential biases, key informant trees appear to be a practical and clinically useful tool for the subjective portion of the community assessment component of COPC.