The following is a summary of “What quantifies good primary care in the United States? A review of algorithms and metrics using real-world data,” published in the June 2023 issue of Primary Care by Wang, et al.

Primary care physicians (PCPs) are essential in delivering comprehensive healthcare and facilitating referrals to specialty care and other medical services. However, the COVID-19 pandemic has disrupted patient access to care, emphasizing the need to understand and evaluate the quality of primary care. Traditional methods of collecting patient surveys can be time-consuming and costly, necessitating the exploration of novel data collection and analysis techniques. For a study, researchers discussed existing algorithms and metrics that utilized real-world data to assess and measure the quality of primary care. Additionally, they examined the strengths and limitations of electronic health records (EHRs) and claims data in evaluating PCP care quality.

Various algorithms and metrics have been developed to assess primary care quality using real-world data. These include identifying the likely PCP for an individual (plurality provider and major provider identification), evaluating process quality (e.g., appropriate-care-model composite measures), and measuring continuity and regularity of care through interval, variance, and relative variance index. They also explored the advantages and limitations of utilizing EHRs and administrative claims data to determine the quality of PCP care. EHR audits enable assessing workflow processes and clinical appropriateness within primary care practices. With its extensive and diverse records, administrative claims data can provide reliable information by assessing primary care quality through coded data from various providers or networks. Leveraging EHRs and claims, data offers a cost-effective analytical strategy for evaluating primary care quality.

In light of the COVID-19 pandemic and its impact on patient access to care, it is crucial to evaluate the quality of primary care. Real-world data, including EHRs and administrative claims data, present opportunities to assess and measure primary care quality using innovative algorithms and metrics. The approaches can provide valuable insights to support patients with complex medical needs in the primary care setting and inform policymakers on potential improvements to the primary care system. By utilizing EHRs and claims data, healthcare stakeholders can employ a cost-effective analytic strategy to evaluate and enhance the quality of primary care services.

Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02080-y