ASSESSING THE QUALITY OF PRIMARY HEALTH CARE IN A REMOTE COUNTY OF TAIWAN

The purpose of this study was to evaluate the association between the quality of primary care and patient-reported health status, patient disease-specific clinical outcomes, and patients’ satisfaction with their care experience in a remote county of Taiwan. The two aims of our evaluation of health care quality were as follows: 1. To validate the Primary Care Assessment Tool (PCAT) in Taiwan, and 2. To examine the associations between domains of primary care quality and patient outcomes. This study was a population-based cross-sectional survey performed on offshore islands northwest of Taiwan with 12,700 inhabitants. The reliability of the PCAT-C was assessed by measuring internal consistency reliability. Factor analysis and construct validity were used in confirming the hypothesis supporting the composite score. This study used the Primary Care Assessment Tool - Chinese Edition (PCAT-C), which includes four core domains (first contact, longitudinality, comprehensiveness, and coordination) and three related domains (family centeredness, community orientation, and cultural competence). A visit-based questionnaire was used to gather information. Our validation analysis (Study Aim 1) shows that all the seven domains of primary care captured in PCAT-C are retained and the PCAT is a valid, reliable and responsible tool with psychometric properties in the multidimensional quantification of primary health care, similar to previous PCAT-related validation effort (H1 & H2). Study Aim 2 examines the associations between domains of primary care quality and patient outcomes. The analysis shows that those with chronic illness performed better than those without in all the primary care domains (H3). The analysis also indicates that primary care overcomes the gaps between different education and income level, but good primary care experience hinges on it adequate supply (H4). The analysis further demonstrates significant association between PCAT quality and satisfaction (H5). Finally, on the relationship between primary care quality and disease-specific clinical outcomes (H6), the analysis yields mixed findings. The Primary Care Assessment Tool provides an excellent method for assessing and identifying ways in which primary care systems can be improved; as such, it is important to ensure that the instrument stays updated and malleable to change as the field of health care evolves. Advisor: Leiyu Shi, Dr.P.H., M.B.A., M.P.A