quality of primary care in Japan, we need vigorous ... although it has significant importance in the healthcare system. Therefore, it is inevitable for primary care.
Journal of General and Family Medicine
2016, vol. 17, no. 4, p. 267–269.
Editorials
Improving Quality of Care through Primary Care Research Machiko Inoue, MD, MPH, PhD Associate Editor, JGFM
This issue of Journal of General and Family Medicine
behavioral, or socioecological, in practice settings or in
covers a variety of topics in original articles, reviews, case reports, and more, from which readers can learn
a population, would be a pursuable area for primary care researchers. Thinking about the topics and
and apply the knowledge in clinical care. Since the
questions that primary care researchers could pursue
research topics in general and family medicine cover a vast field, residents, primary care physicians, and other
would yield a niche in the field. The second tip is to keep the principles of primary care
health professionals who are starting out in research might consider it hard to find a suitable topic to pursue
in mind and revisit them when you are unsure what could be done to recognize the care gap. These
at first. Infinite opportunities abound, and Japan’s primary care medicine lacks evidence obtained from
principles include accessible, comprehensive, coordinated, continuous, and patient-centered, as well as
practice settings, and thus we are unaware of how wide
family- and community-oriented care. In Japan, how-
an evidence-practice gap may exist. To improve the quality of primary care in Japan, we need vigorous
ever, ways to define, assess, and improve the quality of primary care have not yet been established. This is
research conducted within primary care practices. In this editorial, I suggest some tips to help early-stage
partly due to a long history where general medicine/ family medicine has not been recognized as a specialty.
researchers in primary care to generate research
The value and role of primary care are still ambiguous
questions. The first is to pay attention to the quality of care at your own practice or in other settings, and
for patients, healthcare providers, and the public, although it has significant importance in the healthcare
discern any gap between ideal care based on established evidence or suggested by guidelines as “stand-
system. Therefore, it is inevitable for primary care academics to define the standard for primary care
ard,” and the care actually provided at the practice. Any
according to its principles. By doing so, the existence
gap in care that should be narrowed or eliminated as far as possible implies measures toward a solution should
of “gaps in care” could be assessed and efforts toward quality improvement (QI) could take place.
be sought. Practice-based research questions arise from those gaps, along with any uncertainty physicians and
Looking at the recent primary care reform in the United States would provide Japanese researchers some
staff are experiencing. Such gaps have the potential to
insights to think about a framework to reinforce QI in
offer learning opportunities as well as research questions. Moreover, translational or implementation
primary care. Fifteen years ago, the Institute of Medicine (IOM) in the United States issued a keystone
research for an intervention, whether pharmaceutical,
report, “Crossing the quality chasm: A new health
Corresponding author: Machiko Inoue, MD, MPH, PhD Beth Israel Deaconess Medical Center, Harvard Medical School © 2016 Japan Primary Care Association
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Journal of General and Family Medicine
2016, vol. 17, no. 4
system for the 21st century”.1 Since then, pursuit of higher quality and better safety in health care has been
research. The PCMH practices in the United States employ periodic surveys of their patients’ experiences
recognized as a compelling issue, more than ever, and has been discussed along with the sustainability of
with their practice, as an indicator of patient-centeredness. The survey results are utilized for evaluating and
health. In the report, the IOM defined quality of care as
further improving the quality of care. In addition,
following six aims: care should be safe, effective, patient-centered, timely, efficient, and equitable. Im-
involving patients and their families as advisors in QI activities at PCMH practices is recommended. Some
plementation of various polices, including the Affordable Care Act, in terms of primary care, and redesign of
Japanese primary care practices are collecting patient satisfaction data, but whether patients are experiencing
the delivery model by putting into effect the Patient-
the care that a practice should provide may not be
Centered Medical Home (PCMH), have brought a major paradigm shift for primary care practices,
assessed thoroughly enough to change and improve the quality of care. As a starting point for quality
requiring them to have a systematic focus on QI and safety.2 PCMH attempts to shift the medical paradigm
assessment from the perspective of patient-centeredness, conducting a patient survey is a viable option for
from the care of an individual patient by physicians to
primary care researchers. The PCMH initiative uses
care by a team of providers with coordination and communication for various populations. A number of
“the Consumer Assessment of Healthcare Providers and Systems (CAHPS)” surveys to assess patient
tools and external supports for implementing the PCMH were developed and became available for
experiences and create a database.6 To assess patient experiences in primary care practices or for a
primary care practices’ use. External supports for QI include data feedback and benchmarking, practice
population in Japan, a Japanese version of the Primary Care Assessment Tool (JPCAT), a 29-item survey that
facilitation, expert consultation, and learning collabo-
covers five primary care principles, was developed and
2
ratives. Recognition by the National Committee on Quality Assurance (NCQA) has further pushed forward
made available for use.7 Patient-centeredness is not only an important core concept in primary care, but it
the transformative process taking place at practices, which defines the criteria for PCMH practices from
should be practiced as part of a system-based approach, as a measurable entity, in every practice. A first step to
level 1 to 3, with incentives to actively improve the
assessing the quality of care provided in a practice
quality of care and to meet the criteria to earn the recognition of level 3. The NCQA PCMH 2014
could be made from this aspect. With the three suggestions mentioned above, I would
recognition is based on the following six standards: patient-centered access, team-based care, population
encourage investigators to think outside the box, learning from the primary care movement in various
health management, care management and support,
countries, and pursue research to advance the quality of
care coordination and care transition, and performance measurement and quality improvement. Recent studies
primary care in Japan.
show that the implementation of the PCMH model has had some impact on the quality of primary care; it was
References 1 Crossing the Quality Chasm: A New Health
associated with improved cancer screening rates,3
System for the 21st Century. In. Washington (DC):
increased accessibility and patient-physician communication,4 and modest improvement in healthcare
Institute of Medicine (US) Committee on Quality of Health Care in America. 2001.
utilization.5 These efforts and achievements in U.S. primary care practices provide Japanese primary care
2 Quality Improvement in Primary Care - External supports for practices [http://www.ahrq.gov/research/
researchers some implications for practically imple-
findings/factsheets/quality/qipc/index.html].
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3 Markovitz AR, Alexander JA, Lantz PM, Paustian ML: Patient-centered medical home implementation
comes would be an essential approach in primary care
and use of preventive services: the role of practice
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Improving Quality of Care through Primary Care Research
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4 Shi L, Lock DC, Lee DC, et al: Patient-centered medical home capability and clinical performance in
6 CAHPS Surveys and Tools to Advance PatientCentered Care [http://www.ahrq.gov/cahps/index.
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html].
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