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
- 1Department of General Practice, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
Abstract
Objective: The 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.
Methods: Data 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.
Results: The 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.
Conclusion: During 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.
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BibTeX
@article{liu2026threeyear,
title = {{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}},
author = {Ying Liu and Wenping Sun and Qingqing Shi and Hua Shen},
journal = {Journal of Primary Care \& Community Health},
year = {2026},
month = sep,
doi = {10.1177/21501319261494128},
url = {https://doi.org/10.1177/21501319261494128},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Ying Liu
AU - Wenping Sun
AU - Qingqing Shi
AU - Hua Shen
PY - 2026
DA - 2026/09/30
JO - Journal of Primary Care & Community Health
DO - 10.1177/21501319261494128
UR - https://doi.org/10.1177/21501319261494128
AB - Objective: The 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. Methods: Data 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. Results: The 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. Conclusion: During 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.
SN - 2150-1319
SN - 2150-1327
ER -