Evaluation instruments for primary care network structures: an integrative review

Lima, Maria Alice Dias da Silva; Marques, Giselda Quintana; Damaceno, Adalvane Nobres; Santos, Mariana Timmers dos; Witt, Regina Rigatto; Acosta, Aline Marques

doi:10.1590/0103-11042019S524

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REVIEW • Saúde debate 43 (spe5) • Dec 2019 • https://doi.org/10.1590/0103-11042019S524 copy

Evaluation instruments for primary care network structures: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The study aimed to identify available instruments in the literature to evaluate the structure of primary health network in health systems. An integrated review of literature was carried out in health sciences, education, and management Databases, as follows: Medical Literature Analysis and Retrieval System Online (Medline), including the Cochrane Library, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ABI Inform, Latin American and Caribbean on Health Sciences Literature (Lilacs), and the Business Source Complete (Ebsco). Manuscripts published in English and Portuguese from 1995 to 2019 were included. The final sample contained nine articles, in which eight instruments were identified. They had as a common feature the approach on longitudinality, interprofessional communication, care coordination, access to health services, and quality of care. An emphasis was noted on an instrument developed in the Brazilian health system context as a useful tool to support health care workers and managers in the situational diagnosis of potentialities and fragilities of Primary Health Care and Health Care Networks.

KEYWORDS
Health evaluation; Surveys and questionnaires; Primary Health Care

Author/Year/Language	Objective	Design	Country	Name of the instrument
Flocke⁹9 Flocke SA. Measuring attributes of primary care: Development of a new instrument. Journal of Family Practice. 1997; 45(1):64-74. (1997) English	Evaluate the psychometric properties of an instrument developed to measure seven key aspects of primary care provision from the perspective of patients and to verify the association of these aspects with patient satisfaction	Multi-method quantitative cross-sectional study	USA	Components of Primary Care Index (CPCI)
Cassady¹⁰10 Cassady CE, Starfield B, Hurtado MP, et al. Measuring consumer experiences with primary care. Pediatrics. 2000; 105(4):998-1003. (2000) English	Assess the adequacy of the Primary Care Assessment Tool-Child Edition (PCAT-CE) instrument by assessing the scope of the main characteristics of primary care services for children and young people	Quantitative cross-sectional study	USA	Primary Care Assessment Tool-Child Edition (PCAT-CE)
Cooley¹¹11 Cooley WC, McAllister JW, Sherrieb K, et al. The medical home index: Development and validation of a new practice-level measure of implementation of the medical home model. Ambul Pediatr [internet]. 2003 [acesso em 2019 nov 20]; 3(4):173-180. Disponível em: https://doi.org/10.1367/1539-4409(2003)003<0173:TMHIDA>2.0.CO;2. https://doi.org/10.1367/1539-4409(2003)0... (2003) English	Describe the development and validation of a tool to measure home health care	Cross-sectional study	USA	Medical Home Index (MHI) - Long version
Nikbakht-Van¹²12 Nikbakht-Van M, Pruyn JFA, Van der Rijt CCD. Function of local networks in palliative care: A Dutch view. J Palliat Med. 2005; 8(4):808-816. (2005) English	Assess the opinions and experiences of participants regarding the structure, process and results of palliative care networks in the southwestern Netherlands	Qualitative and quantitative study	Netherlands	Questionnaire with no name specified
Friedberg¹³13 Friedberg MW, Safran DG, Coltin KL, et al. Readiness for the patient centered medical home: Structural capabilities of Massachusetts Primary Care Practices. J Gen Intern Med. 2008; 24(2):162-9. (2008) English	Assess the prevalence of recommended structural capacities among primary care practices and to determine whether prevalence varies between practices of different dimensions (number of doctors) and administrative affiliation with health care networks	Cross-sectional study followed by literature search	USA	Questionnaire with no name specified
Rittenhouse¹⁴14 Rittenhouse DR, Casalino LP, Gillies RR, et al. Measuring the medical home infrastructure in large medical groups Health Aff (Millwood). 2008; 27(5):1246-1258. (2008) English	Examine the extent of infrastructure component adoption among large primary care and other medical specialty groups and their association with the number of available doctors	Quantitative cross-sectional study	USA	Questionnaire with no name specified
Birnberg⁽¹⁵15 Birnberg JM, Drum ML, Huang ES, et al. Development of a Safety Net Medical Home Scale for Clinics. Journal of General Internal Medicine [internet]. 2011 [acesso em 2019 nov 20]; 26(12):1418-1425. DOI: https://doi.org/10.1007/s11606-011-1767-9 https://doi.org/10.1007/s11606-011-1767-... ⁾ (2011) English	Develop primary care assessment scale using Patient Centered Medical Home (PCMH) model	Cross-sectional study	USA	Safety Net Medical Home Scale (SNMHS)
Rodrigues⁽¹⁶16 Rodrigues LBB, Leite AC, Yamamura M, et al. Coordenação das redes de atenção à saúde pela atenção primária: validação semântica de um instrumento adaptado. [Coordination of primary healthcare networks: Semantic validation of an adapted instrument]. Cad. Saúde Pública. 2014; 30(7):1384-1390.⁾ (2014) Portuguese	Perform the semantic validation of the health care network coordination assessment tool by primary care, adapted from the evaluation checklist of the degree of integration of health care networks	Cross-sectional study	Brazil	Assessment Tool for the Coordination of Primary Health Care Networks by PHC (Copas)
Rodrigues⁽¹⁷17 Rodrigues LBB, Santos CB, Goyata LT, et al. Assessment of the coordination of integrated health service delivery networks by the primary health care: COPAS questionnaire validation in the Brazilian context. BMC Family Practice. 2015; 16(87):1-9.⁾ (2015) English	Present the results of the construct validation (pilot phase) of the Copas instrument to evaluate the coordination of health care networks by primary care.	Cross-sectional study	Brazil	Assessment Tool for the Coordination of Primary Health Care Networks by PHC (Copas)

Authors	Instrument	Respondents	Study Scenario	Strategy of data collection	Dimensions of the instrument	Psychometric properties
Flocke⁹9 Flocke SA. Measuring attributes of primary care: Development of a new instrument. Journal of Family Practice. 1997; 45(1):64-74. (1997)	Components of Primary Care Index (CPCI)	2.899 users assisted by family doctors	Family Doctor's Offices in Ohio (USA)	Instrument applied in person by researchers at study sites	Multidimensional (4): interpersonal communication, knowledge about the patient, coordination of care, preference of the patient to care with his/her family doctor	Internal consistency
Cassady¹⁰10 Cassady CE, Starfield B, Hurtado MP, et al. Measuring consumer experiences with primary care. Pediatrics. 2000; 105(4):998-1003. (2000)	Primary Care Assessment Tool-Child Edition (PCAT-CE)	450 parents and caregivers of children and young people under 18	Primary Care Services in Washington, DC (USA)	Instrument applied by telephone	Multidimensional (5): Longitudinality/relationship, accessibility of first contact, coverage of available services, coverage of services provided, coordination	Content and construct validity, internal consistency
Cooley¹¹11 Cooley WC, McAllister JW, Sherrieb K, et al. The medical home index: Development and validation of a new practice-level measure of implementation of the medical home model. Ambul Pediatr [internet]. 2003 [acesso em 2019 nov 20]; 3(4):173-180. Disponível em: https://doi.org/10.1367/1539-4409(2003)003<0173:TMHIDA>2.0.CO;2. https://doi.org/10.1367/1539-4409(2003)0... (2003)	Medical Home Index (MHI) - Long version	Doctors and non-doctors members of the health team of 43 health units	43 pediatric primary care units in various states of the USA	Instrument applied in person by researchers at study sites	Multidimensional (6): organizational capacity, management of chronic conditions, coordination of care, community extension, data management, improvement of quality	Construct validity and internal consistency
Nikbakht Van¹²12 Nikbakht-Van M, Pruyn JFA, Van der Rijt CCD. Function of local networks in palliative care: A Dutch view. J Palliat Med. 2005; 8(4):808-816. (2005)	Questionnaire	59 respondents, including managers and health professionals	8 local palliative care networks in Rotterdam (Netherlands)	Self-applicable instrument sent by e-mail	Contains 200 items divided into structure (demographic characteristics, history, beginning, development stage, resources and organizations participating in the network), process (organization and administration, cooperation and external relations) and result (shared objectives and perceptions, demands for care, quality of cooperation, improvement of care services, established agreements, results associated with patients and organizations, expertise and funding)	No psychometric validation reported
Friedberg¹³13 Friedberg MW, Safran DG, Coltin KL, et al. Readiness for the patient centered medical home: Structural capabilities of Massachusetts Primary Care Practices. J Gen Intern Med. 2008; 24(2):162-9. (2008)	Questionnaire with no name specified	308 doctors working in primary care	Primary Care Units in Massachusetts (USA)	Self-applicable instrument sent to participants	Multidimensional (4): patient care and reminders, culture of striving for quality, improved access, electronic health records	No psychometric validation reported
Rittenhouse¹⁴14 Rittenhouse DR, Casalino LP, Gillies RR, et al. Measuring the medical home infrastructure in large medical groups Health Aff (Millwood). 2008; 27(5):1246-1258. (2008)	Questionnaire with no name specified	291 health service managers	Independent medical groups and practice associations in the USA	Instrument applied by telephone	Multidimensional (7): personal doctor, doctor-directed medical practice with responsibility for ongoing patient care, comprehensive patient guidance, coordinated/integrated care, quality and safety with evidence-based decisions, timely access to care, and improved communication methods between patients and healthcare team, payment should be commensurated with patient care and outcomes	No psychometric validation reported
Birnberg¹⁵15 Birnberg JM, Drum ML, Huang ES, et al. Development of a Safety Net Medical Home Scale for Clinics. Journal of General Internal Medicine [internet]. 2011 [acesso em 2019 nov 20]; 26(12):1418-1425. DOI: https://doi.org/10.1007/s11606-011-1767-9 https://doi.org/10.1007/s11606-011-1767-... (2011)	Safety Net Medical Home Scale (SNMHS)	Health service managers assisted by the health team	65 rural and urban clinics (USA)	Self-applicable instrument sent by e-mail	Multidimensional (6): access and communication, patient and record follow-up, care management, referral testing and follow-up, quality improvements, external coordination	Content validity, internal consistency and convergent validity
Rodrigues¹⁶16 Rodrigues LBB, Leite AC, Yamamura M, et al. Coordenação das redes de atenção à saúde pela atenção primária: validação semântica de um instrumento adaptado. [Coordination of primary healthcare networks: Semantic validation of an adapted instrument]. Cad. Saúde Pública. 2014; 30(7):1384-1390. (2014) Rodrigues¹⁷17 Rodrigues LBB, Santos CB, Goyata LT, et al. Assessment of the coordination of integrated health service delivery networks by the primary health care: COPAS questionnaire validation in the Brazilian context. BMC Family Practice. 2015; 16(87):1-9. (2015)	Assessment Tool for the Coordination of Primary Health Care Networks by PHC (Copas)	Health professionals linked to the Family Health Strategy	Health Units with Family Health Strategy in Minas Gerais (Brazil)	In person self-applicable instrument	Multidimensional (5): population, Primary Health Care, support systems, logistics systems, management system	Internal consistency, content validity, convergent and discriminatory, ceiling and floor test

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[1] Collaborators

Lima MADS (0000-0002-3490-7335)^* * Orcid (Open Researcher and Contributor ID). contributed to the design and planning of the study, data analysis and interpretation, drafting, critical review of the content, and approval of the final version of the manuscript. Marques GQ (0000-0003-2567-4602)^* * Orcid (Open Researcher and Contributor ID). contributed to the conception and planning of the study, data analysis and interpretation, drafting, critical review of the content and approval of the final version of the manuscript. Damaceno AN (0000-0002-4681-0602)^* * Orcid (Open Researcher and Contributor ID). contributed to data analysis and interpretation, drafting, critical review of the content, and approval of the final version of the manuscript. Santos MT (0000-0002-3336-050X)^* * Orcid (Open Researcher and Contributor ID). contributed to data analysis and interpretation, drafting, critical review of the content and approval of the final version of the manuscript. Witt RR (0000-0002-3893-2829)^* * Orcid (Open Researcher and Contributor ID). contributed to the conception and planning of the study, drafting, critical review of the content and approval of the final version of the manuscript. Acosta AM (0000-0002-4816-6056)^* * Orcid (Open Researcher and Contributor ID). contributed to data analysis and interpretation, drafting, critical review of the content, and approval of the final version of the manuscript.