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Research Questions

  1. What definitions and assessment methods of productivity, input, and output in primary care have been suggested?
  2. Which tools relevant to primary care productivity exist to help organizations address primary care productivity?
  3. What is the consensus regarding key aspects of primary care productivity across diverse stakeholders?

At present, there is a lack of consensus on how to define and assess primary care clinic productivity. To address this need, the authors reviewed relevant literature and convened a diverse set of stakeholders to explore definitions and assessment of productivity, input, and output in primary care; identify tools relevant to primary care productivity; and establish consensus on key aspects of primary care productivity.

The authors built on a systematic review of patient panel size, conducted a rapid review exploring the operationalization of input and output in biomedical research (as well as a rapid review to identify tools for health care delivery organizations), and performed additional scoping searches. The research evidence informed a structured panel process that brought together subject-matter experts and key stakeholders. In pre- and post-panel surveys, panelists provided valuable insights into the concept of productivity in primary care and identified key elements of primary care productivity from system, provider, and patient points of view. Structured panel discussions focused on the challenges of assessing productivity with feasible, reliable, and valid methods.

The authors found that approaches to assessing and improving primary care productivity would benefit from methods for measuring productivity at the primary care practice level, tools to assess both individual providers and primary care teams, and the integration of practice context and quality of care into productivity assessments. These findings highlight the need for meaningful conceptual, analytic, management, and improvement approaches to primary care productivity.

Key Findings

  • Research studies often do not define productivity, and most identified studies used a pragmatic operationalization of output.
  • The broad approaches to operationalizing output in the literature were throughput-focused (e.g., number of patients seen), procedure-focused (e.g., number of individual health care services delivered), and revenue-focused (e.g., financial earning).
  • Health care systems should develop approaches for measuring productivity at the primary care practice level.
  • Health care systems should provide primary care practice leaders with tools for assessing the productivity of individual providers and of primary care teams.
  • Assessment of the context of a primary care practice is important for interpreting and improving variations in practice-level productivity.
  • Additional development of analytic approaches for integrating key characteristics (such as quality) of primary care outputs into productivity measurement systems is needed.
  • Additional development of management and improvement approaches and tools for optimizing primary care productivity is needed.
  • Productivity assessment and management are not meaningful for improving primary care unless the quality—in addition to the quantity—of care provided is accounted for in some way.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Results

  • Chapter Four

    Discussion

  • Appendix A

    Search Strategies

  • Appendix B

    Surveys

  • Appendix C

    Evidence Table

  • Appendix D

    Tool Kit

Research conducted by

This research was commissioned by the Veterans Health Administration (VHA) and conducted by the Access and Delivery Program in RAND Health Care.

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