A Three-Year Longitudinal Analysis of Primary Care Quality Improvement Under a Regional Inspection Program in Shanghai: an Evaluation Using the PDSA Cycle as an Analytical Framework.

Authors

Ying Liu, Wenping Sun, Qingqing Shi, Hua Shen

Published in

Journal of primary care & community health. Volume 17. Pages 21501319261494128. Epub Sep 30, 2026.

Abstract

ObjectiveThe Plan-Do-Study-Act (PDSA) continuous quality improvement theory was adopted as the analytical framework. An analytical approach combining static feature identification and dynamic trend tracking was employed to describe longitudinal trends in quality indicators during the implementation of regional general practice quality control inspections.MethodsData from general practice quality control inspections conducted in 18 community health centers within a district of Shanghai from 2023 to 2025 were used as the primary data source. Trend classification and, Friedman nonparametric test, Jonckheere-Terpstra (JT) test, and Kendall's W test were employed for analysis.ResultsThe scores for the basic conditions of regional general practice tended to stabilize, while dimensions such as talent cultivation improved year by year. The fluctuation in scores for general practitioners' disease diagnosis and treatment capabilities was kept within 19.1%. The fluctuation in scores for the management of common health problems and diagnostic and standardized care also did not exceed 19.3%, and was generally consistent with the trend in diagnosis and treatment capabilities. Longitudinal analysis revealed that the scores for basic conditions, general practice quality management, talent training and discipline construction of general practice improved continuously, whereas a slight decline was observed in the scores for the management of common health problems and standardized care. Statistically significant changes were observed in the scores of these four dimensions. General practitioners' diagnosis and treatment capabilities showed a non-significant Friedman test but a significant Jonckheere-Terpstra monotonic trend, indicating consistent improvement despite fluctuations. Based on the slope of total score changes, the 18 community health centers were classified into improvement-type and stable-type centers; the distribution between the two types varied according to the slope threshold applied.ConclusionDuring the three-year period of quality control inspections, an overall upward trend in regional primary care quality scores was observed. Within the PDSA cycle, the inspection and execution steps have been routinized, whereas closed-loop feedback remains to be strengthened. This study provides a scientific basis for evaluating the effectiveness of regional primary care quality interventions and offers a reference for promoting the high-quality and sustainable development of the regional general practice system.

PMID:
42814037
Bibliographic data and abstract were imported from PubMed on 30 Sep 2026.

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