Original Research

Validating the Adult Primary Care Assessment Tool

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Limitations

Interpretation of our results should take into account some limitations. First, because our study was restricted to 1 locale, the generalizability of the PCAT-AE to other sites and states is not assured. Additional testing and validation is necessary to corroborate the current results. Second, the 74-item questionnaire remains lengthy and could have contributed to relatively high nonresponse and incompletion rates. Future validation work will concentrate on further reduction of the items to the very essential in order to reduce response burden. Regarding the ceiling effect of first contactutilization, future tests will be conducted in other settings with less of a managed care focus, as there well may be quite different distributions of responses in other settings. Third, outcomes of primary care are not the focus of the assessment tool. However, numerous studies have linked primary care to better health outcomes. Subsequent research may help explain which attributes are most conducive to better outcomes so that limited resources can be used to focus on them or a combination of them. Fourth, the measurement of primary care achievement is entirely based on respondents self-report. While self-report may be the best way to ascertain peoples experiences, it is subject to recall and response bias. Moreover, some aspects of technical quality cannot be assessed by patientsor consumers reports.

Despite these limitations, PCAT-AE is a valuable tool for capturing the principal domains of primary care. The next phase of our work seeks to assess the predictive validity of PCAT-AE, by examining the extent to which the principal attributes of primary care can be linked to the achievement of favorable health outcomes, their ability to manage their illnesses, and their satisfaction with the care received. Such work would advance our understanding of the relationship between how primary care is delivered and the health outcomes that result.

Related technical terms

Primary Care Attributes

First contactcare implies accessibility to and use of services for each new problem or new episode of a problem for which people seek health care.

Longitudinalitypresupposes the existence of a regular source of care and its use over time.

Comprehensivenessimplies that primary care facilities must be able to arrange for all types of health care services, including referrals to secondary services for consultation, tertiary services for specific conditions, and essential supporting services, such as home care and other community services.

Coordinationof care requires some form of continuity, either by practitioners, medical records, or both, as well as recognition of problems that are addressed elsewhere and the integration of their care into the total care of patients.

Family centerednessrefers to recognition of family factors related to the genesis and management of illness.

Community orientationrefers to the providers knowledge of community needs and involvement in the community.

Cultural competencerefers to the providers adaptation to facilitate relationships with populations having special cultural characteristics.

Measurement Concepts

Measurement validityrefers to the extent that important dimensions of a concept and their categories have been taken into account and appropriately operationalized.

Measurement reliabilityrefers to the extent that consistent results are obtained when a particular measure is applied to similar elements.

Construct validityis present when the measure captures the major dimensions of the concept under study.

Content validityrefers to the representativeness of the response categories used to represent each of the dimensions of a concept.

Concurrent validitymay be tested by comparing results of one measurement with those of a similar measurement administered to the same population and at approximately the same time. If both measurements yield similar results, then concurrent validity can be established.

Predictive validity exists when the results obtained from the measurement succeed in predicting the expected later-occurring event or circumstance.

Test-retest reliabilityinvolves administering the same measurement to the same individuals at 2 different times. If the correlation between the same measures is high, then the measurement is believed to be reliable.

Split-half reliabilityinvolves preparing 2 sets of measurement of the same concept, applying them to research subjects at one setting, and comparing the correlation between the 2 sets of measurement. To the extent the correlation is high, then the measurement is reliable.

Interrater reliabilityinvolves using different people to conduct the same procedure, whether it be interview, observation, coding, rating, and the like, and comparing the results of their work. To the extent that the results are highly similar, interrater reliability is established.

Item-convergent validityrefers to the substantial correlation between each item and its hypothesized scale.

Item-discriminant validityrefers to items within a scale that correlate more substantially with their hypothesized scale than with any other scale.

Equal item variancerefers to items within a scale that have approximately equal means and variances.

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