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Developing a New Measure of Primary Care Using the Medical Expenditure Panel Survey

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To develop and assess the reliability of a measure of primary care using items from the Medical Expenditure Panel Survey (MEPS), a US representative survey of community-dwelling persons.


On the basis of the domains from the literature on primary care characteristics, we identified relevant items within the 2013–2014 MEPS family of surveys. In a sample of primary survey respondents with at least 1 office-based physician visit in the last 12 months, we conducted exploratory factor analysis, retaining items with a factor loading of 0.30 and factors ≥3 items. Using a hold-out sample, internal consistency, reproducibility, and confirmatory factor analyses were performed.


On the basis of 16 care domains, we found 32 candidate items in the MEPS. Factor analyses of data from 4549 persons meeting inclusion criteria (27.6% of the total sample), yielded 3 unique factors involving 24 items. We named these subscales Relationship, Comprehensiveness, and Health Promotion, displaying internal consistency reliability of 0.86, 0.78, and 0.69, respectively. Confirmatory factor analysis corroborated the stability of the exploratory findings in the hold out sample. Sensitivity analyses showed robustness to differences in underlying correlation structure, alternative approach to missing data, and extension to indirect survey respondents.


The MEPS Primary Care measure with 3 subscales is reliable and may be useful in conducting primary care health services and outcomes research in the rich MEPS dataset. Further validation is needed, and is described in a companion paper.
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Keywords: comprehensiveness; confirmatory factor analysis; exploratory factor analysis; health promotion; measure; measurement; patient experience; primary care; relationship

Document Type: Research Article

Affiliations: 1: Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 2: Department of Family Medicine, Oregon Health & Science University, Portland, OR 3: Departments of Population and Quantitative Health Sciences 4: Population and Quantitative Health Sciences, and the Case Comprehensive Cancer, Center Case Western Reserve University 5: Center for Community Health Integration, Departments of Family Medicine & Community Health, Population and Quantitative Health Sciences, Sociology, and the Case Comprehensive Cancer Center Case Western Reserve University, Cleveland, OH

Publication date: June 1, 2019

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