Adaption of Primary Care Assessment Tool for Evaluation of Primary Care Achievements Under China's Healthcare Reform

Wang, Harry HX

Background: China is undergoing a comprehensive healthcare reform which systematically strengthens community-based primary care services. National guidelines call for multiple models of Community Health Centres (CHCs) to deliver universally accessible primary care services in order to enhance the service capacity.

Objectives: This study aimed to cross-culturally adapt the internationally well-developed Primary Care Assessment Tool (PCAT) into mainland China to measure the extent and quality of primary care services under different delivery models.

Methods: A Mandarin Chinese version of PCAT-AS was developed based on the modified Brislin’s model of translation and the equivalence testing was used to evaluate the quality of translation. Multistage cluster sampling method was adopted in the study. Interviewers were trained to establish and improve inter-rater reliability. ANOVA is used to test for significant differences among different delivery models in total PCAT scores regarding primary care achievements.

Results: The overall means scores for comparability of language and similarity of interpretability were 2.93 and 2.28, respectively, which indicated that the items were conveyed and interpreted satisfactorily. The inter-rater reliability was 0.82 which indicated an excellent agreement among raters. A total of 3,080 questionnaires were collected with an overall response rate of 86.1%. The total PCAT scores varied significantly across different primary care service delivery models (P<0.001). Primary care service provided by CHCs of government-owned model received the highest PCAT total score of 103.64 (95%CI: 102.43 to 104.84) compared to services provided under private-owned and hospital-owned model, and was also superior in terms of First Contact domain and Coordination domain of primary care.

Conclusion: This mandarin Chinese version of PCAT-AS was applicable for Chinese people which accounts for one-fifths of the world population. Future work includes the exploration of the relationship between primary care achievements and characteristics of different delivery models, which could provide evidence-based policy recommendations for healthcare reform.