Starfield Summit: Developing a National Strategic Vision for Primary Care

Virginia Commonwealth University, Richmond VA

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Abstract

Project Summary Background: The US Health Care System needs quality measures adequate to the task of assessing, valuing, and fostering continuous improvement within the fields of primary care. Policymakers and health care leaders have called for a reduction in the number of quality measures applied to primary health care. Reducing the number of primary care measures used will reduce administrative burden associated with measurement reporting. However, with a focus on adaption of current measures rather than redesign, these efforts fail to address the challenges endemic to our current measurement system. These challenges include: a myopic focus on disease-specific clinical processes and outcomes; measures reactive to the needs of policy and payment rather than proactively informed by health and healing; misrepresentation and underrepresentation of primary health care's contributions; a disconnect between health outcomes important to patients and those items being measured; and absence of a unified vision regarding what we should measure and why. In 1978, the World Health Organization (WHO) Alma-Ata conference established that robust primary health care is foundational to any high performing health care system. Barbara Starfield's 1994 identification of the key attributes of primary care ? first contact, relationship-based continuity, whole person comprehensive care, and coordination ? is globally accepted as standard. Despite clear definition and agreement regarding the function and attributes of primary care, our ability to define and identify quality in primary care remains elusive. Purpose: To develop a stakeholder informed operational definition for quality in primary care; to define a conceptual framework able to guide development of meaningful primary care measures; to identify key attributes and functions of primary care in which quality indicators are lacking; and to create a strategic plan for the development of meaningful measures actionable within the next year. Methods: We will bring together a unique combination of primary care stakeholders and leaders for a three- day conference that incorporates both large and small group discussion. Issue Briefs, designed around five basic questions will define each question, describe its importance, provide a bulleted account of best evidence to date, and suggest focused areas for group discussion. The five questions are: 1) what is quality in primary care, 2) what is the purpose of measuring it, 3) what would best practice for measurement five years from now look like, 4) what are the opportunities available or to be created for getting us there, and 5) who needs to be part of our community of solution. Benefit: Shifting the structure of quality primary care measures is possible and necessary for the successful revitalization of the US primary care system. This conference will be the first stakeholder-led effort to create a conceptual framework and unified vision able to assess and report the value of primary care to the national achievement of the Triple Aim: improved population health, better patient experience, and smarter spending.