Framework for primary care organizations: the importance of a structural domain

Purpose. Conceptual frameworks for primary care have evolved over the last 40 years, yet little attention has been paid to the environmental, structural and organizational factors that facilitate or moderate service delivery. Since primary care is now of more interest to policy makers, it is important that they have a comprehensive and balanced conceptual framework to facilitate their understanding and appreciation. We present a conceptual framework for primary care originally developed to guide the measurement of the performance of primary care organizations within the context of a large mixed-method evaluation of four types of models of primary care in Ontario, Canada. Methods. The framework was developed following an iterative process that combined expert consultation and group meet-ings with a narrative review of existing frameworks, as well as trends in health management and organizational theory. Results. Our conceptual framework for primary care has two domains: structural and performance. The structural domain describes the health care system, practice context and organization of the practice in which any primary care organization operates. The performance domain includes features of health care service delivery and technical quality of clinical care. Conclusion. As primary care evolves through demonstration projects and reformed delivery models, it is important to evalu-ate its structural and organizational features as these are likely to have a significant impact on performance