The conceptual framework of primary care quality assessment and quality of primary care perceived by patients in China

Background. Primary care is a cornerstone of any health care system. However, despite the unanimous recognition of the importance of primary care, the quality of primary care has failed to attract adequate attention in the past. As the world regains its interest in primary care, the time is right to emphasize a long-term strategy for strengthening primary care.;Aims. This dissertation has two major aims. The first major aim is to conceptualize the primary care quality assessment at three levels: provider and patient, health care system and community, and national contextual framework and population. The second aim is to examine the quality of primary care from the perspective of patients in China across different health care settings including CHCs as well as urban and suburban outpatient hospitals. In pursing these aims, this dissertation reveals the heterogeneous nature of primary care quality assessments, prioritizes guided efforts for a sustainable development of primary care, and explores factors that shape the perceived quality of primary care.;Methods. To address the first aim, this dissertation drew upon the findings and lessons from previous studies to establish a template for primary care quality assessment. To address the second aim, in-depth interviews were conducted with patients in 18 selected health care providers in Changsha, the capital city of Hunan province in China with the adapted Chinese version Primary Care Assessment Tool (PCAT-C).;Findings. Drawing upon the information from the literature we retrieved, the first manuscript established a template for a primary care quality assessment at three levels and provided insights about how coordinated, prioritized, and stepwise primary care quality assessment strategies could assure the sustainable development of primary care. Manuscript Two and Manuscript Three demonstrate a practical application for how viewing quality from the patients' perspectives can generate starting points for identifying possible areas for improvement across a wide spectrum of core services in China.;Conclusions. With considerable international attention focused on strengthening patient-centered primary care, this work demonstrates the significance of the strategically comprehensive and scientifically prioritized planning and monitoring of primary care. Moreover, it demonstrates the feasibility of obtaining patients' perceptions of quality of primary care with reliable instruments.