Predictive Validity of the Tool for Advancing Practice Performance (TAPP), a New Measure to Assess Primary Care Performance

Context: Many tools measuring the overall quality of primary care exist but none have established predictive validity with respect to care quality and patient outcomes.

Objective: To establish the predictive validity of the Tool for Advancing Practice Performance (TAPP), a new, rigorously developed, low-burden practice-level survey for assessing primary care structures (e.g., use of electronic health records) and processes (e.g., panel management).

Study Design and Analysis: We invited a national sample of 401 primary care practices to complete the TAPP survey from December 2021 to March 2022. We obtained electronic health records (EHR) data reflecting 6 quality of care and 2 clinical outcome measures; each measure reflects the proportion of patients receiving the appropriate care or with a good clinical outcome. Overall primary care performance was assessed as the average of the 8 measures. We used linear regression analysis to assess the relationship between TAPP scores and outcomes data.

Setting or Dataset: United States Population Studied: 247 practices had complete TAPP and EHR outcomes data. These practices varied in size, ownership type, and patient population served.

Intervention/Instrument: TAPP Outcome Measures: Use of statin therapy, use of aspirin/antiplatelet for ischemic vascular disease, documentation of BMI with follow-up for obesity, screening and follow-up for depression, screening for breast cancer, screening and referral for smoking, blood pressure control, HbA1c control Results: The total TAPP score was positively associated with the overall performance measure. For a one-point increase on the overall survey score, which reflected the difference between the worst and best possible survey score, there was an increase of 0.24 on the overall performance score (95% CI: 0.16 – 0.32, p<.001). The total TAPP score was positively associated with 3 of the quality-of-care measures (breast cancer screening, p<.001; depression screening and follow-up, p<.001; smoking screening and referral, p<.001). Adjusting for percentage of patient caseloads enrolled in Medicaid or non-white did not affect the associations appreciably.

Conclusions: The TAPP is a rigorously developed, low-burden tool consisting of 113 items for assessing practice-level primary care structures and processes. It is the first such tool to predict primary care practice performance as measured by quality of care and clinical outcomes.