Clinical Scorecard: Assessing Primary Care’s Core Contributions: Continuity, Trust, and Stewardship

At a Glance

Key Highlights

• Common measures such as visits, codes, screenings, and disease targets may miss important contributions of primary care.
• A proposed Primary Care Value Dashboard would assess whether care is accessible, relational, integrated, and effective in supporting people to live well over time.
• Continuity can persist across multiple clinicians when the patient’s history, goals, and care plan are recognized and integrated.
• Stewardship includes helping patients obtain necessary care while avoiding low-value tests, referrals, treatments, and burdens.
• The article recommends initially using patient-reported measures for learning and quality improvement rather than payment.

Guideline-Based Recommendations

Diagnosis

Management

• Initially use patient-reported measures to support learning and quality improvement, identify barriers, redesign care, and understand patient experience.
• The article describes adaptable payment models as a way to finance care management, outreach, behavioral health integration, coordination, and access.

Monitoring & Follow-up

• Routinely assess patient-reported access, continuity, trust, coordination, and treatment burden.
• The article describes fragmented measurement efforts and calls for further work on applying measures to improve care, inform payment, and reinforce accountability.

Risks

• Visit-, code-, screening-, and disease-target-focused metrics may overlook primary care contributions outside appointments, including coordination and avoidance of unnecessary services.
• Fee-for-service inadequately rewards continuity, stewardship, and coordination, much of which occurs between visits or averts visits.

Patient & Prescribing Data

Patients receiving primary care; the article does not specify a disease-specific population.

The article discusses measurement of patient experience and care functions, not specific medications or prescribing regimens. Stewardship includes avoiding low-value medications and other treatment burdens.

Clinical Best Practices

• Assess access beyond appointment availability, including contact with the care team, prompt direction, and movement through services without avoidable obstacles or extended waits.
• Assess continuity across clinicians by whether the patient’s story, goals, and care plan remain familiar and integrated.
• Use treatment-burden instruments to quantify health care workload and its effects on patients’ lives.
• Consider patient-defined goals and quality of life alongside disease-specific targets when measuring primary care value.
• Initially use patient-reported measures for learning and quality improvement rather than payment.

Related Resources & Content

• 1. Barbara Starfield’s four Cs of primary care
• 2. National Academies characterization of primary care as a common good
• 3. Treatment burden instruments
• 4. Measures of continuity
• 5. Person-Centered Primary Care Measure
• 6. NCQA Person-Centered Outcome Measures
• 7. Comprehensive Primary Care Initiative