Community Oriented Primary Care A Practical Assessment, Vol. 1: Report of a Study (1984) / Chapter Skim
Currently Skimming:
An Operational Model of Community-Oriented Primary Care
An Operational Model of Community-Oriented Primary Care
Pages 27-46
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From page 27... ...
The model accounts for partis1 expressions of the COPC concept and provides a mechanism for defining the sage of develops ment of COPC activities for each of several functions. This model defines COPC in its most geners1 form as the provision of urimarY care services to ~ defined community, coupled with systematic efforts to identify and address ache major health problems of that communitv through effective modifications both of the primary care servicer and other appropriate co_~.
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From page 28... ...
a systematic process by which the practice, with the participation of the community, identifies and addresses the major health problems of the community; this process consists of four activities: ~ ~ def inition and character ization of the community 2) identification of the community ' s health problems 3' modification of the health care program in response to the community health needs 41 monitoring the impact of program modifications.
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From page 29... ...
The mechanism to assure that the services provided to the patient population are accessible, comprehensive, coordinated, and continuous is quality assurance and is an integral component of the primary care process. Thus, as a basic structural element of COPC, primary care can be defined as that array of health services provided by a practitioner to a patient that is accessible and acceptable to the patient, comprehensive in scope, coordinated and continuous over time, and for which the practitioner is accountable for the quality and potential effects of the services.
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From page 30... ...
Thus, primary care outside of Me COPC model strives to provide its active patients (the ~numerator. in a COPC context} with effective and appropr late health services that are accessible, comprehensive, continuous, coordinated, and accountable.
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From page 31... ...
While producing results that my benefit the active patient population and thus greatly improve the primary care program, such activities do not promote the central notion of COPC. In the ideal COPC practice, the focus of the community participation involves the entire community and grapples with identifying health problems and setting priorities Dung them for subsequent program modifications.
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From page 32... ...
In the absence of rigorous methods for collecting and analyzing ache data on ache community, ache primary care practitioner may often erroneously generalize patterns of health and health behavior from his patient population {the numerator' to the total community (the denominator)
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From page 33... ...
of the practice} they are characteristic of excellent primary care but not of COPC. TABLE 4.1 Staging Criteria for COPC Function~De fining and Characterizing ache Community STAGE 0: No effort has been made to define or charac~cerize ~ community beyond the active users of the practice.
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From page 34... ...
Identifying Community Health Problems The second function in the COPC process is to identify the major health problems of the community, characterize their determinants and correlates, and set priorities among them. As in the previous function,
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From page 35... ...
Although many practices may be examining the patterns of health and health care problems among their active patient population, such practices are engaged in quality assurance and as such may be practicing excellent priory care, but that alone does not mean they are practicing COPC. Similarly, the practices that attempt to identify community health problem- solely by generalizing from the health problems of their patient population are not practicing COPC a" it relates to thin function.
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From page 36... ...
At stage III, the practice identifies and examines community health problems with data sets that are specific to that community. Activities at siege TII, however, tend to focus on specific health issues, and runs the risk of overlooking a major problem simply because it was not included in the scope of the cats set.
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From page 37... ...
Thus, in the ideal situation program modifications will be targeted appropriately at a . subset of the denominator oom~unity {rather than focused on active patients} and will often require some form of outreach or a combination of primary care and community health program strategies.
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From page 38... ...
STAGE I: Modifications address health problems believed to exist in the community, but are made more in response to a national or organization-wide initiative than in response to a particular problem specifically identified in the community. STAGE II: Modifications address important community health problems, but are chosen largely because of the availability of special resources to address that particular problem, and closely follow guidelines that may not be tailored to the community needs.
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From page 39... ...
Maving done so one can proceed logically to ache final function-designing a mechanism for monitoring the impact of the program modif ications . Monitoring the Impact of Program Modifications In the final function, the practice must monitor the effectiveness of the program modifications in order to determine ache extent to which it has addressed and resolved the original problem.
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From page 40... ...
At stage 0, the practice is assessing program effectiveness by examining the impact on the active users of the health care services. The denominator of such an evaluation does not reflect the entire community, asked although evaluations of this type are appropr late to orthodox prosy are, they do not meet the requirement for COPC.
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From page 41... ...
it is expected that stage IV activities also will examine outcomes (e.g., a change in the r ates of per inatal morbidity} . _ In Canary, COPC in Its most generic form 18 defined as me pr~lsion of primary care services to a defined community, coupled with systematic efforts to identify and address the major health problems of that community through effective modifications in both the primary care services and other appropriate community health programs.
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From page 42... ...
that consists largely of active patients, a considerable amount of confusion ar ises. For example, the practice that is actively identifying the major health problems of its Captives patient population, modifying its primary care activities to address the problems, and monitoring the impact of program modifications may be practicing excellent primary care.
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From page 43... ...
a quality assurance activity, but with a concern for a broader community that consists of nonpatients as well as active users of primary care services. COPC is a set of activities to assure that the priory care services system is directing its pr injury care capability toward the health problems that are most important for the health of the overall community, including both users and nonusers of service.
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From page 44... ...
Thus, within a system of finite resources and a limited capability of primary care to influence overall health Lotus, the role of CO9C may be to shift the attention of the health care program toward health issues and 'subsets of ache community in which additions] benef it is possible .
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From page 45... ...
1983 Preliminary Evaluation Report: Medical Record Abstraction Data, Robert Wood Johnson Foundation Teaching Bospital General Medicine Group Practice Program Evaluation, UCLA School of Medicine, L:os Angeles, CA. Hobel, C.J.
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Key Terms
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