Effects of quality on outcomes in primary care: a review of the literature.

It is widely believed that health care quality affects primary care outcomes, but the evidence is fragmented and incomplete. The authors searched MEDLINE for relevant articles published between 1950 and 2006 and reviewed the evidence to assess the relationship between the personal aspects of primary care quality and patients' health status and health services utilization. These personal aspects, which include patient-physician continuity and communication, are distinct from the technical aspects of primary care, which include ordering tests, treatments, and referrals. Fourteen articles met the inclusion criteria. Results showed that greater continuity of care is associated with less use of hospitals and emergency departments and lower health care costs; effective communication may be associated with better health status. The limited available evidence suggests that higher quality in the personal aspects of primary care is associated with some but not all outcomes of care. Additional research is needed to define these relationships more clearly.