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International Journal for Quality in Health Care Advance Access originally published online on November 30, 2007
International Journal for Quality in Health Care 2008 20(5):308-313; doi:10.1093/intqhc/mzm054
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© The Author 2007. Published by Oxford University Press on behalf of International Society for Quality in Health Care (ISQua); All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

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

William Hogg1, Margo Rowan2, Grant Russell1, Robert Geneau3 and Laura Muldoon1

1 C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, Ontario, Canada
2 Rowan Health Policy Consulting, Ottawa, Ontario, Canada
3 Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada

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 meetings 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 evaluate its structural and organizational features as these are likely to have a significant impact on performance.

Keywords: conceptual framework, organizational theory, performance measurement, primary care, quality of health care

Address reprint requests to William Hogg, C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, Ontario, Canada. Tel: +613-562-4262; Fax: +613-562-4266; E-mail: whogg{at}uottowa.ca


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