Comparison of Indicators of Health System Performance and Clinical Processes Between Facilities With and Without Family Physicians
| Tool and Indicator | Without Family Physicians, Mean Value (SD) | With Family Physicians, Mean Value (SD) | Mean Difference (95% CI) | P Value |
|---|---|---|---|---|
| District hospitals | ||||
| Signal functions (essential services) tool (n = 22) | ||||
| Newborn care, % | 92.7 (6.4) | 95.0 (6.5) | −2.29 (−8.05 to 3.46) | .42 |
| Maternal care, % | 89.1 (19.2) | 96.2 (5.4) | −7.05 (−20.21 to 6.11) | .28 |
| Surgery, % | 63.6 (24.5) | 76.4 (16.7) | −12.73 (−31.80 to 6.34) | .18 |
| General medicine, % | 65.8 (17.8) | 78.0 (21.0) | −12.17 (−29.41 to 5.07) | .16 |
| Mental health, % | 83.3 (15.1) | 80.8 (7.9) | 2.50 (−8.55 to 13.55) | .64 |
| Pediatric care, % | 69.2 (15.1) | 85.0 (14.3) | −15.83 (−28.99 to −2.67) | .02 |
| Emergency care, % | 78.3 (20.0) | 90.0 (15.6) | −11.67 (−27.85 to 4.52) | .15 |
| South African National Core Standards tool (n = 19) | ||||
| Score for Domain 2 (focuses on aspects of patient safety, clinical governance, and clinical care) | 76.25 (24.79) | 89.79 (14.28) | −13.54 (−35.20 to 8.11) | .19 |
| Child PIP tool (n = 26) | ||||
| In-hospital mortality rate (number of deaths per 100 pediatrics admissions) | 2.9 (2.3) | 1.4 (1.3) | 1.50 (−0.06 to 3.06) | .059 |
| Modifiable factor rate per death (number of modifiable factors identified per audited pediatric death, ie, instances of suboptimal care or missed opportunities) | 4.7 (3.9) | 2.2 (1.9) | 2.49 (0.18 to 4.96) | .049 |
| Perinatal PIP tool (n = 26) | ||||
| Perinatal mortality rate (number of perinatal deaths per 1,000 total births, all deliveries) | 26.74 (12.13) | 23.32 (7.79) | 3.42 (−4.53 to 11.38) | .38 |
| Neonatal mortality rate (number of neonatal deaths per 1,000 live births, all deliveries) | 10.75 (7.02) | 7.44 (3.53) | 3.31 (−1.01 to 7.63) | .13 |
| Stillbirth rate (number of stillbirths per 1,000 total births, all deliveries) | 17.54 (9.30) | 16.64 (5.39) | 0.90 (−5.34 to 7.14) | .77 |
| Community health centers | ||||
| PCAT tool completed by health care users (n = 30)a | ||||
| First-contact use (care is first sought from the primary care clinician when a new health need arises; a behavioral characteristic) | 3.41 (0.42) | 3.22 (0.34) | 0.19 (−0.10 to 0.50) | .19 |
| First-contact access (services must be accessible; a structural characteristic) | 2.52 (0.99) | 2.48 (0.93) | 0.04 (−0.70 to 0.80) | .90 |
| Continuous (ongoing) care (longitudinal use of a regular source of care over time, resulting in a long-term relationship between clinician and patient) | 3.03 (0.31) | 2.79 (0.29) | 0.24 (0.02 to 0.50) | .03 |
| Coordination of care (linking of health care visits and services so that patients receive appropriate care for all their health problems) | 3.51 (0.39) | 3.05 (0.55) | 0.45 (0.10 to 0.80) | .02 |
| Coordination of information (the essence of coordination is the availability of information about prior and existing problems and services) | 3.41 (0.43) | 3.16 (0.47) | 0.25 (−0.10 to 0.60) | .14 |
| Comprehensiveness: services available (availability of a wide range of primary care services) | 3.32 (0.44) | 3.16 (0.43) | 0.16 (−0.20 to 0.50) | .31 |
| Comprehensiveness: services provided (appropriate provision of primary care services, including services that promote and preserve health) | 3.33 (0.62) | 3.15 (0.58) | 0.18 (−0.30 to 0.60) | .41 |
| Family-centeredness (appropriate care that recognizes the family as a major participant in patient assessment and treatment) | 3.37 (0.52) | 2.97 (0.63) | 0.40 (−0.02 to 0.80) | .07 |
| Community orientation (care that is delivered in the context of the community) | 2.83 (0.58) | 2.63 (0.57) | 0.20 (−0.20 to 0.60) | .34 |
| Cultural competency (care that honors and respects the beliefs, interpersonal styles, attitudes, and behaviors of people as they influence health) | 3.52 (0.49) | 3.24 (0.49) | 0.28 (−0.10 to 0.60) | .13 |
| Primary health care team (availability of other members of the primary health care team, such as physiotherapists, social workers, dentists, dietitians, mental health workers, and community health workers) | 3.52 (0.52) | 3.24 (0.52) | 0.28 (−0.10 to 0.70) | .15 |
| Integrated CDM audit score | ||||
| Structural aspects required for chronic disease management, % (n=25) | 72.45 (19.04) | 72.55 (22.57) | −0.10 (−17.46 to 17.23) | .99 |
| Diabetes score, % (n = 27) | 39.48 (10.85) | 40.55 (13.79) | −1.07 (−10.86 to 8.73) | .82 |
| Hypertension score, % (n = 28) | 45.96 (10.99) | 44.59 (13.66) | 1.37 (−8.27 to 11.00) | .77 |
| Asthma score, % (n = 25) | 47.41 (8.08) | 42.28 (8.08) | 5.13 (−1.60 to 11.87) | .13 |
| COPD score, % (n = 18) | 32.24 (16.90) | 29.49 (15.98) | 2.75 (−13.85 to 19.34) | .73 |
| Epilepsy score, % (n = 26) | 35.78 (18.51) | 39.01 (16.26) | −3.23 (−17.45 to 10.99) | .64 |
CDM = chronic disease management; COPD = chronic obstructive pulmonary disease; PCAT = Primary Care Assessment Tool; PIP = Problem Identification Program.
↵a Scored from 1 = definitely not to 4 = definitely; higher scores indicate better care.