DEFINING PRIMARY-CARE - EMPIRICAL-ANALYSIS OF THE NATIONAL AMBULATORYMEDICAL-CARE SURVEY

OBJECTIVES. Efforts to contain health care costs have increased intere st in defining which specialties provide primary care and in developin g tools to assess the delivery of primary care services. METHODS. Usin g data from the 1985-1991 National Ambulatory Medical Care Surveys, th e authors examined the activities of 29 physician specialty groups to determine whether the recent Institute of Medicine definition of prima ry care could be operationalized. Ten elements were identified that ad dressed comprehensiveness (first-contact care, a Herfindahl Index, pre vious contact for other problems, prevention, and care through the lif e cycle), coordination (referrals), continuity (any previous contact), and accessibility (care provided to black patients, those on Medicaid , and patients in rural areas), RESULTS. Principal component and facto r analyses suggested that each element, except care through the life c ycle, contributed to the construct of primary care. Principal componen t analysis enabled ordering of specialties according to their ''primar y careness,'' suggesting that specialties other than family/general pr actice, pediatrics, and internal medicine make significant contributio ns to primary care. Factor analysis suggested that two factors related to process and content underlie the definition of primary care and em phasize the importance of integration of services provided. This analy sis provides a basis for further empirical work to develop measures of primary care performance. CONCLUSIONS. National surveys need to be mo dified;to provide a more comprehensive assessment of primary care in t he United States.