The quality of primary care in community health centers: comparison among urban, suburban and rural users in Shanghai, China.
OBJECTIVE
Following World Health Organization's initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions.


METHODS
Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience.


FINDINGS
A total of 2404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß = 1.57, P <  0.001) compared with those from urban CHCs.


CONCLUSION
That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).
['Shi|Jianwei|J|', 'Jin|Hua|H|', 'Shi|Leiyu|L|', 'Chen|Chen|C|', 'Ge|Xuhua|X|', 'Lu|Yuan|Y|', 'Zhang|Hanzhi|H|', 'Wang|Zhaoxin|Z|', 'Yu|Dehua|D|']
D002681:China D003151:Community Health Centers D003430:Cross-Sectional Studies D018166:Health Care Reform D006801:Humans D011320:Primary Health Care D011634:Public Health D011787:Quality of Health Care
Quality Primary care Community health centers PCAT