Table 1.
Primary care quality constructs derived from two IoM reports and their ordinal ranking among patients and provider/experts in homeless health carea
| IoM construct | Statements ranked in card sort exercise: “Primary care should …” | Homeless patients | Provider/experts in homeless care |
|---|---|---|---|
| Accessibility | Be easy to get | 1 | 1 |
| Evidence-based decision making | Be based on the best medical knowledge | 2 | 2 |
| Cooperation | Mean all of those who take care of a patient to work as a team and talk to each other | 3 | 4 (tied with source of control) |
| Coordination | Make sure a patient can get all the services they need even if it is from more than one person | 4 (tied with shared knowledge) | 6 |
| Shared knowledge and the free flow of information | Make it easy for patients to get information about their care | 4 (tied with coordination) | 14 |
| Accountability for addressing majority of health needs | Meet most of a patient’s health needs, most of the time | 6 | 3 |
| Sustained partnership | Mean the provider and the patient work together over a long period of time | 7 | 12 |
| Continuous (not just visit-based) healing relationships | Be available any time or any place patients need it | 8 | 10 |
| Anticipation of needs | Plan for a patient’s future needs, instead of waiting for persons to say they have a need | 9 | 7 |
| Patient as a source of control | Give patients control in their health care | 10 | 4 (tied with cooperation) |
| Safety as a system priority | Keep in mind safety | 11 | 11 |
| Transparency | Allow patients to know how well their primary care providers do their jobs | 12 | 15 |
| Choices in primary care should be based on a patient’s values | Be based on your values | 13 | 8 |
| Decrease in waste, optimize value | Not waste money or time | 14 | 16 |
| Context of community and family | Keep in mind the people who are in a patient’s life or not in a patient’s life | 15 | 13 |
| Context of community and family | Keep in mind where a person lives | 16 | 9 |
Notes:
a
The ordinal ranking shown in this table (from 1 to 16) was obtained as follows. We computed the mean value (ie, its position within the deck of 16 cards provided) for each construct, separately for patients and providers. These mean values were then ordered from lowest (most important) to highest (least important) to illustrate their relative importance to patients and to providers.
Abbreviation: IoM, Institute of Medicine.